Children's Orthopaedics

Question 1

how does knee alignment change during childhood?

Answer 1

newborn has genu varus (bow legged)
1.5 - 2 yrs = straight
2.5 yrs = slight genu valgus
4-6 yrs = straight allignment

Question 2

what indicates that an abnormality may be a problem and not just something that will resolve?

Answer 2

unilateral

Question 3

what is the definition of a deformity?

Answer 3

something likely to persist and cause physical or mental health problems later in life

Question 4

how does bone grow longitudinally?

Answer 4

from the growth plate (physis) by echondral ossification

Question 5

how does bone grow circumferentialy?

Answer 5

from the periosteum by appositional growth

Question 6

females lose bone density at a faster rate than males, true or false?

Answer 6

false

both at the same rate but males start with a higher bone density

Question 7

what happens at the growth plate?

Answer 7

stacking of chondrocytes - they die and act as scaffold for new bone laid down by osteoblasts

Question 8

which part of the bone is most vulnerable to fracture in childhood?

Answer 8

growth plate?

Question 9

what factors affect the growth plate?

Answer 9

diet
sunshine - vit D&A
injury
illness
hormones (growth hormone)

Question 10

is short stature always pathological?

Answer 10

no
only 1 in 5 children 2SD below normal have a pathological reason
growth is very variable <3 y/o

Question 11

normal movement at 6-9 months?

Answer 11

sits alone

crawls

Question 12

normal movement at 8-12 months?

Answer 12

stands

Question 13

normal movement at 14-17 months?

Answer 13

walking

Question 14

normal movement at 24 months?

Answer 14

jumping

Question 15

normal movement at 3 years?

Answer 15

can manage stairs alone

Question 16

normal cerebral development at 1-6 months?

Answer 16

loss of primitive reflexes - moro, grasp, stepping, fencing

Question 17

normal cerebral development by 2 months?

Answer 17

head control

Question 18

normal cerebral development by 9-12 months?

Answer 18

few words

Question 19

normal cerebral development by 14 months?

Answer 19

feeds self

uses spoon

Question 20

normal cerebral development by 18 months?

Answer 20

stacks 4 blocks

understands 200 words

Question 21

normal cerebral development by 3 years?

Answer 21

potty trained

Question 22

give 4 common variations of normal in children

Answer 22

genu varum or valgum
intoeing
flat feet
curly toes

Question 23

what is varum?

Answer 23

bow legged

Question 24

what is valgum?

Answer 24

knock kneed

Question 25

how does varum/valgum vary with age?

Answer 25

infant = varuk
18 months = straight
3.5 years = valgum
7 years = straight

Question 26

who is genu varum normal in?

Answer 26

age <2

persisting varum can run in families

Question 27

what are 5 abnormal causes for genu varum?

Answer 27

skeletal dysplasia
rickets - Vit D deficiency
tumour
blounts disease
trauma - physeal injury

Question 28

what is blounts disease?

Answer 28

arrest of growth at the medial tibia growth plate causing growth disorder and varum deformity

Question 29

what does blounts disease look like?

Answer 29

typical beak like protrusion on X ray

Question 30

what can cause genu valgum?

Answer 30

tumours
rickets
neurofibromatosis
idiopathic

Question 31

when can genu valgum be normal?

Answer 31

until around 3.5 years

Question 32

when would genu valgum require referral or treatment?

Answer 32

if asymmetric, painful or severe

if >8cm intramalleolar distance at age 11 - need surgery

Question 33

what is intoeing?

Answer 33

child walks with toes pointing in

“pigeon toed”

Question 34

how can you exaggerate intoeing?

Answer 34

running

Question 35

what can cause intoeing?

Answer 35

femoral neck anteversion
internal tibial torsion
metatarsus addctus
combination

Question 36

what is femoral neck anteversion and what is the classical presentation?

Answer 36

inward twisting of the femur (usually points anteriorly)

children sitting in the “W” position

Question 37

how can femoral neck anteversion be tested for?

Answer 37

get child to lie prone

bend knees and rotate legs outwards

Question 38

what can femoral neck anteversion cause risk of?

Answer 38

patellofemoral problems

Question 39

what is internal tibial torsion and how is it treated?

Answer 39

inward twisting of the tibia
usually seen in toddlers <3 but vast majority resolve by 6 yrs
usually none needed, surgery done in very rare cases

Question 40

what is metatarsus adductus?

Answer 40

curving of the foot towards the medial side

benign and usually resolves

Question 41

what is usually done for intoeing?

Answer 41

no treatment
find cause and reassure
might chart, photograph and review

Question 42

what is flat feet?

Answer 42

medial arch doesn’t develop in childhood as tibialis posterior strengthens

Question 43

what are the symptoms of flat feet?

Answer 43

usually none

no proven consequences

Question 44

how do you test flat feet?

Answer 44

stand on toes to determine if flexible or fixed
- flexible = arch appears
- fixed = stays flat
calf tightness assessment

Question 45

what can cause flexible and fixed flat feet?

Answer 45

flexible - ligament laxity or tightness

fixed - bony connection known as tarsal coalition

Question 46

what must you remember to check with anterior knee pain?

Answer 46

hips

Question 47

what is curly toes?

Answer 47

toes (usually 3rd or 4th) are scrunched up

common in young children and usually resolves by 6 yrs